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01 March 2015

Medicinal Cannabis and Chronic Pain in Australia

Australians suffering from chronic pain may get more relief from their symptoms using cannabis than they do from some conventional medications, researchers have found.

A large study of people suffering from chronic problems such as back pain, migraine and arthritis has discovered many are turning to cannabis to relieve their symptoms, despite already being prescribed heavy-duty opioid medications such as morphine and oxycodone.

Experience of adjunctive cannabis use for chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) study; •There is increasing debate about the use of cannabis for medical purposes, including chronic non-cancer pain (CNCP) •In 1,514 people prescribed opioids for CNCP, 16% had used cannabis for pain. •A quarter reported that if they had access to cannabis, they would use it for pain relief. •Those using cannabis for pain were younger, with greater pain severity and interference. •They had been prescribed opioids for longer and were on higher opioid doses.

In a finding that is likely to further intensify the debate about medical cannabis use, the National Drug and Alcohol Research Centre (NDARC) researchers found people who used the illegal drug said it was more helpful than the highly addictive and potentially dangerous opioid medications.

Millions of Australians suffer from chronic pain - a problem set to increase as the population ages. Yet there are few effective and safe long-term treatments, and accidental overdose deaths from prescribed pain drugs are now more common than deaths from heroin. Study leader Louisa Degenhardt found nearly 13% of 1,500 chronic pain patients, who were mainly aged in their late 40's and early 50's, had used cannabis in the past year despite being prescribed opioids. This compared to only 4.7% of the rest of the population, she wrote in the journal Drug and Alcohol Dependence. "One in three said they found it very effective to relieve their pain, that's a score of ten out of ten," she said. "Now these are all subjective scores but it means there is definitely a group of people who think that taking it was very beneficial." Professor Degenhardt, from NDARC and the University of Melbourne said the study raised important questions about whether the benefits of cannabis for pain should be more seriously explored, but also about the negative effects of drugs, such as patient dependence. "The people who were also trying cannabis for pain, they were younger but they had also been living with pain for longer," she said. "Their pain was so severe it had been interfering with their lives."

Study co-author Nicholas Lintzeris, a medical doctor specialising in addiction and Associate Professor of Addiction Medicine at the University of Sydney, said there had been a huge rise in the number of Australians seeking treatment for addiction to pain medications. This was linked to a lack of multi-disciplinary treatment such as physiotherapy and massage, leaving doctors with little choice but to prescribe heavy-duty painkillers, or even other drugs for which there was little evidence of efficacy, such as antidepressants or antipsychotics. "Interestingly, in the US (as there has been more use of medicinal cannabis there), we are starting to see some large epidemiological studies that indicate cannabis use might provide options other than simply an ever-escalating opioid dose (when treatment isn't working)," he said.

The definition focuses on the symptoms that may be relieved through the use of cannabis and connects those symptoms to various illnesses or conditions as follows: • symptoms associated with, or with treatment for, one or more of the following: • an illness or condition that is likely to result in death, • Human Immunodeficiency Virus (HIV), • severe and treatment-resistant nausea and vomiting due to chemotherapy, • pain associated with cancer, • neuropathic pain, • a symptom associated with, or with treatment for, a medical condition declared by the regulations to be a symptom that may be relieved by the use of cannabis, • a symptom associated with, or with treatment for, a medical condition certified by the patient’s medical practitioner as a symptom suffered by the patient that may be relieved by the use of cannabis.

Greens NSW MP John Kaye said the NDARC paper provided more evidence that both the Liberal and Labor parties were being too cautious. "It is irrational and cruel to criminalise patients who are obtaining relief from chronic non-cancer pain using medicinal cannabis," he said. Waiting for yet more evidence before changing the law is a delaying tactic that will see tens of thousands of people suffer debilitating levels of pain needlessly."